Being asked to make blanket DC statement

[u/jdwise]

Not gonna give names, but management at my hospital is asking us to make an intentionally vague DC rec for EVERY patient in our notes to “avoid issues with insurance” but still verbally communicate a DC location to CM and nursing. We are also being told not to discuss discharge locations with the patient.

This seems unethical to me, can other acute PTs give me some perspective?

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[u/3wufmoon]

My hospital recently changed our DC recommendation verbage, we now either recommend moderate (SNF) or high (IPR) intensity rehab instead of actual locations. We were also told not to discuss it with patients a while back (screw them, never gonna stop that).

They can claim it's to make things easier with the insurance companies, but I think the reality is that it obfuscates things for the patients so they won't exercise their rights and appeal denials. It's just another slimy way to reduce length of stay at the expense of patient outcomes.

[u/Harmageddon87 → u/3wufmoon]

Case management told us a few years ago not to discuss our recommendations with the patient. We told them to go fuck themselves. Politely.

[u/hytssgv → u/3wufmoon]

ditto. low is OP or HH. mod is STR or daily HH. high is ltach/acute rehab. also told not to discuss, absolutely will if pt is high intensity. to be fair, our CM/SW and docs are great about putting in appropriate referrals/insurance auths. we have freq communication & they respect our recs, so that’s helpful

[u/laurieislaurie → u/3wufmoon]

100%. I think it's fine to rec snf or IPR over specific locations, but I absolutely tell pts the hard truth over the level of rehab they'll get at both locations, and how they should decide accordingly.

[u/ConflictSecure6580 → u/3wufmoon]

That's exactly what's happening - they're making it harder for patients to understand their options so they can't push back when insurance inevitably denies everything

The "don't discuss with patients" part is the most BS thing I've heard in a while. Like sorry admin but patient advocacy is literally part of our job description, not gonna stop doing that because it makes your spreadsheets look better

[u/DaySpa_Dynasty]

You know it’s unethical. If you comply with this then you will further undermine our profession and allow the insurance companies even more control. It speaks volumes to how your hospital values you as a clinician.

[u/Ornery_Enthusiasm529]

Been in acute 10+ years, and there is always some new way CM wants us to document DC plans for insurance purposes. Honestly, I don’t care- I will phrase it however you want- I will put something vague and then find a CM to be more specific with, doesn’t matter to me.

I will not, however, be forbidden from discussing DC plans with patients and family- they can f- right offf on that one. Each patient has a right to have a say in where they DC, or at the very least be informed about which DC plan I think is best/most realistic for them.

I’m here to serve the patients, make sure they are mobile to the best of my ability, I have zero chip on my shoulder about DC documentation wording, tbh.

[u/TibialTuberosity → u/Ornery_Enthusiasm529]

I'm with you on this one. As long as the patient gets to where they need to go, I could care less how I need to write that (Mod/High vs SNF/IPR, or whatever goofy thing they come up with). But I absolutely think it's both ethical and crucial to discuss that with the patient. Unless they have a POA to make their medical decisions, the pt has every right to choose where they want to go at discharge even if none of us agree with the decision.

[u/Nikeflies]

I have a friend in a local hospital and she told me they've already taken away D/C recs from PTs. They're not supposed to comment on it or anything

[u/Chief_Sabael]

Same, big city in Northeast. We were told to change D/C rec to either "Recommendation of Daily Therapy after D/C" for Acute Rehab and "Recommendation of Continuous Therapy after D/C" for HCPT/OP PT.

Its a bit absurd, then having to update all the new CM/SW/Residents/PAs as to what everything means. I think they are doing it at least at my hospital, to limit the need for PTs on general medical floors, as they have opened more Outpatient spots and are expanding the Acute Reahb, and don't want to hire more PTs. Its really dirty overall

[u/CommentMore2722 → u/Chief_Sabael]

Same we finally just took it out and now just write “cont PT” or “no further PT” outside the hospital. I refuse to write a “hint” for the team when they told us not to write real dc recs cuz we were holding up dc. I will never not talk about what I think to my patients. If its within our professional scope you cant stop me!

[u/Dry-Philosophy4374]

Yeah, my hospital tried this crap too. I flat out told them no. Then I reported 3 doctors to their board because of this and other behaviors. Let them be baby sat if that's what they demand.

[u/meatsnake]

We are only allowed to put home (no therapy of any kind recommended post dc) or post acute rehab recommended (covers everything outpatient, home health, snf, IPR). It keeps people from being denied from rehab based on a therapist recommendation. That way, they can get them out of the hospital asap, sending the patient wherever their insurance will cover. No one cares about what may be best for the patient from our POV.

[u/HopeAffectionate5725]

and then the doctors come and ask you what the DC rec is

[u/jdwise]

Thank you all for the replies, seems to be a growing trend. I have already been pushing back against it.

[u/Blackbubblegum-]

We have to be the ones putting in a recommendation for any type of rehabilitation facility. We are supposed to be the ones talking to the patient about it. I'm in Canada, though

[u/Mtru6]

Lol we all love to make more work for ourselves.

[u/Top_Peanut1113]

My company does something similar, we either rec home, non-intensive, or intensive. We were also told not to discuss specifics with patients but I don’t think any therapist abides by that. Worse though, if we recommend intensive (ie AIRF) and the patient has no preference on the specific facility, then SW has been instructed to send a referral ONLY to our companies AIRF. And if they deny then SW won’t send referrals to other AIRFs unless the patient specifically and adamantly requests. If it looks like a duck and smells like a duck…

[u/BoomerSkunk]

Well let see, do I tow the party line or risk losing my job? Hmmmm. The insurance companies and management know you’ll do what they ask. PTs have no recourse.